1 型肝肾综合征患者 90 天预后危险因素分析及预测模型构建.

Objective To investigate the risk factors for the 90-day prognosis of patients with decompensated liver cirrhosis and type I hepatorenal syndrome (HRS). Methods A retrospective analysis was performed for the clinical data of 299 patients with decompensated liver cirrhosis and type I HRS who were hospitalized in Beijing Ditan Hospital from October 2008 to October 2018, and according to the 90-day prognosis, they were divided into survival group with 135 patients and death group with 164 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the influencing factors for 90 day prognosis, and the receiver operating characteristic (ROC) curve was plotted for each factor. Results The univariate analysis showed that there were significant differences between the two groups in Model for End-Stage Liver Disease (MELD) score, Child - Turcotte - Pugh (CTP) score, hepatic encephalopathy, serum Na, (AST), total bilirubin (TBil), albumin (Alb), cholinesterase (CHE), white blood cell count (WBC), neutrophil (NE), neutrophil to-lymphocyte ratio (NLR), red blood cell count (RBC), red blood cell distribution width (RDW), platelet count (PLT), and international normalized ratio (INR) (P<0.05). The multivariate logistic regression analysis showed that Na (odds ratio [OR]=0.918, 95% confidence interval [CI]: 0.880-0.957, P<0.05), BUN (OR=1.077, 95% CI: 1. 0291. 127, P <0.05), RDW (OR=1.019, 95% CI: 1.005-1. 032, P<0.05), and INR (OR = 3.478, 95% CI: 2.096-5. 771, P<0.05) were independent influencing factors for poor 90-day prognosis in patients with decompensated liver cirrhosis and type I HRS. A predictive model, HRS-D, was established u sing the four factors above, and the ROC curves were plotted for each factor to calculate the area under the ROC curve (AUC), which showed that HRS -D had an AUC of 0.813 (95% CI: 0.762-0.864), with a sensitivity of 76. 50% and a specificity of 72. 50% at the diagnostic cut-off value of -1.264. There was a significant difference between HRS -D score and MELD score (Z=3.804, P<0.001), while there was no significant difference between HRS - D score and CTP score and between CTP score and MELD score (both P>0.05). Conclusion Na, BUN, RDW, and INR are independent influencing factors for poor 90-day prognosis in patients with decompensated liver cirrhosis and type I HRS, and the predictive model based on these indices can better predict the 90-day prognosis of HRS patients. [ABSTRACT FROM AUTHOR]